Telehealth denials

Murkjp

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Grand Rapids, MI
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I work for a Mental Health hospital and during the pandemic last year were providing inpatient services via Telehealth. If both the provider and the patient were at the hospital just in different rooms and the there was an audio/video encounter, does the claim still need to billed as Telehealth service? With POS location 02 and Modifier of GT applied. Or could this encounter be billed like a standard inpatient service? With POS 51, no modifier. We have received some denials due to POS not matching with the E/M service provided. Using 99231-99233 subsequent encounter codes.

Thank you
 
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Hello, you would report the encounters as in-person visits. From CMS: https://www.cms.gov/files/document/03092020-covid-19-faqs-508.pdf
Question: Should on-site visits conducted via video or through a window in the clinic suite be reported as telehealth services? How could a physician or practitioner bill if this were telehealth?

Answer: Services should only be reported as telehealth services when the individual physician or practitioner furnishing the service is not at the same location as the beneficiary. If the physician or practitioner furnished the service from a place other than where the beneficiary is located (a “distant site”), they should report those services as telehealth services. If the beneficiary and the physician or practitioner furnishing the service are in the same institutional setting but are utilizing telecommunications technology to furnish the service due to exposure risks, the practitioner would not need to report this service as telehealth and should instead report whatever code described the in-person service furnished. New: 4/9/20
 
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Location
Sulphur, KY
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I work for a Mental Health hospital and during the pandemic last year were providing inpatient services via Telehealth. If both the provider and the patient were at the hospital just in different rooms and the there was an audio/video encounter, does the claim still need to billed as Telehealth service? With POS location 02 and Modifier of GT applied. Or could this encounter be billed like a standard inpatient service? With POS 51, no modifier. We have received some denials due to POS not matching with the E/M service provided. Using 99231-99233 subsequent encounter codes.

Thank you
What Payer?
 
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